Healthcare Provider Details

I. General information

NPI: 1144878943
Provider Name (Legal Business Name): EYE ASSOCIATES OF NEW MEXICO, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 CERRILLOS RD STE 300
SANTA FE NM
87507-4418
US

IV. Provider business mailing address

8801 HORIZON BLVD NE STE 360
ALBUQUERQUE NM
87113-1563
US

V. Phone/Fax

Practice location:
  • Phone: 505-375-8955
  • Fax: 505-404-0795
Mailing address:
  • Phone: 505-246-2622
  • Fax: 505-715-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER KRISTIN TERRY
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 505-246-2622